Revised Food and Nutrition Facts Label--A Step Forward...more to go

As the obesity epidemic continues unabated in the United States, costing more than $190 billion per year in health care expenditures,1 a public health crisis is unfolding that warrants careful reevaluation of existing policies to combat obesity and related chronic diseases. Recently, the US Food and Drug Administration (FDA) announced the first major amendment of the Nutrition Facts Label in more than 2 decades, to be implemented in the next 2 to 3 years, to reflect the evolving evidence related to dietary factors and risk of chronic diseases. The collective changes update the list of nutrients that are required or permitted to be declared, provide reference Daily Values based on current dietary recommendations or consensus reports, adjust serving sizes and labeling requirements for certain package sizes, and revise the overall format and appearance of the label for enhanced interpretability.2

The label provides point-of-purchase nutrition information in a standardized format to help guide consumers’ food and beverage choices. All packaged food items regulated by the FDA—everything from breads and cereals to canned and frozen foods, snacks, desserts, and beverages—are required to display information on the label pertaining to serving size, number of servings, total energy, and a selection of nutrients based on their role in chronic disease etiology or nutrient deficiency: energy from fat, total fat, saturated fat, cholesterol, sodium, carbohydrates, dietary fiber, sugar, protein, vitamin A, vitamin C, calcium, iron, and, most recently, transfat. With more than 61% of US adults reporting that they use the Nutrition Facts panel when deciding to purchase food, these labels have great visibility and potential to be important tools for public education and policy.3

Many people are already familiar with this label, and it is taught in some schools. It is fairly straight forward, however many people who need to know this the most seem to be unaware of what it contains, and how it simplifies what you should buy and eat.  It is not complicated.

Perhaps the most important part of the label is the Calories in each serving. Taking all other things in to consideration generally less is good. However what is in those calories is of major importance. Think of calories as energy, or gasoline in your car's fuel tanks. Calories can also be  equated with 'heat'. Your body produces heat by burning calories,  for breathing, basal metabolism, physical activity, and brain  power.  Your brain consumers about 25% of your caloric supply. 

Think of your fuel tank as containing 'good fuel and bad fuel'  Good fuel is burned efficiently and does not create toxic emissions when burned.  Bad fuel is not used efficiently and produces toxic byproducts which may be harmful to your brain and other cells.  

Look at the total number of fat calories in each serving. The total number of calories of fat should be less than 30% in  your daily diet. Be careful not to confused this with the % age of daily calories of fat in each serving.

Be that as it may some people just don't read or pay attention to the guidelines.  Would you put leaded gas in your tank? At one time many cars could burn leaded gas which raised the octane (power rating) of gas.  Today all cars have catalytic converters, and there is no leaded gas in the United States. (leaded gas destroys catalytic converters which contain platinum. 

And like the fuel industry, government is now regulating some foodstuffs, especially those containing large amounts of added sugar (soda).  The new labeling requirement for added sugar is timely and accompanies other policy initiatives aiming to reduce intake of sugar-sweetened beverages and added sugars. For example, in 2015 Berkeley, California, implemented an excise tax of 1¢ per ounce on sugar-sweetened beverages, and San Francisco, California, recently passed a ruling to issue health warning labels on sugar-sweetened beverages. Boston, Massachusetts, has prohibited the sale of sugar-sweetened beverages on city property, and many school districts have banned sales and vending of these beverages as strategies to help curb childhood obesity. Similar to the case of trans fat, these collective legislative actions to reduce added sugar intake can create an environment that fosters and supports behavioral change toward more healthful choices and are more 

Another factor is the amount of trans-fats (bad), the amendment to the original label was the addition of a required line for trans fat content, implemented in 2006 in response to substantial evidence linking intake of trans fat to adverse cardiometabolic health. This provided a strong incentive for manufacturers to eliminate trans fat; together with city- and state-level regulatory action limiting trans fat use in restaurants it has been largely eliminated from the US food supply. The FDA recently announced removing trans fat from the “generally regarded as safe” category, setting a 2018 deadline for the US food industry to eliminate it from all products. The substantial reduction in trans fat intake, from 4.6 to 1.3 g/d,4 accounted for about half of the improvement in US diet quality since 2000 and is likely a major factor contributing to improvements in blood lipid levels5 and a decline in type 2 diabetes in the United States.6

 

The new changes will further align the label with current dietary guidelines.7 One important change is the addition of a line disclosing “added sugar” content. The Daily Value (% DV) for added sugar is 10% of calories, representing a limit of 50 g (roughly 12 teaspoons) of added sugar for a 2000-calorie diet, a typical daily intake for adults (Figure). Although intake of added sugar has decreased in recent years in the United States, consumption still exceeds recommendations, with the average adult consuming 22 teaspoons of added sugar per day. Sugar-sweetened beverages alone account for 39% of all added sugar intake.7 Intake of sugar-sweetened beverages and added sugar is associated with weight gain and increased risk of type 2 diabetes and cardiovascular disease.8 Based on these data, the 2015-2020 Dietary Guidelines for Americans recommend limiting added sugar intake to less than 10% of daily calories.7 Once the changes are implemented, the label on a 20-oz (591 mL) bottle of soda, for example, would indicate that individuals are consuming 130% of their added sugar limit for the day (for a 2000-calorie diet).

New Hope for Stroke Patients

Background and Purpose—Preclinical data suggest that cell-based therapies have the potential to improve stroke outcomes.

Methods—Eighteen patients with stable, chronic stroke were enrolled in a 2-year, open-label, single-arm study to evaluate the safety and clinical outcomes of surgical transplantation of modified bone marrow–derived mesenchymal stem cells (SB623).

Results—All patients in the safety population (N=18) experienced at least 1 treatment-emergent adverse event. Six patients experienced 6 serious treatment-emergent adverse events; 2 were probably or definitely related to surgical procedure; none were related to cell treatment. All serious treatment-emergent adverse events resolved without sequelae. There were no dose-limiting toxicities or deaths. Sixteen patients completed 12 months of follow-up at the time of this analysis. Significant improvement from baseline (mean) was reported for: (1) European Stroke Scale: mean increase 6.88 (95% confidence interval, 3.5–10.3;P<0.001), (2) National Institutes of Health Stroke Scale: mean decrease 2.00 (95% confidence interval, −2.7 to −1.3; P<0.001), (3) Fugl-Meyer total score: mean increase 19.20 (95% confidence interval, 11.4–27.0; P<0.001), and (4) Fugl-Meyer motor function total score: mean increase 11.40 (95% confidence interval, 4.6–18.2; P<0.001). No changes were observed in modified Rankin Scale. The area of magnetic resonance T2 fluid-attenuated inversion recovery signal change in the ipsilateral cortex 1 week after implantation significantly correlated with clinical improvement at 12 months (P<0.001 for European Stroke Scale).

Conclusions—In this interim report, SB623 cells were safe and associated with improvement in clinical outcome end points at 12 months.

Clinical Outcomes of Transplanted Modified Bone Marrow–Derived Mesenchymal Stem Cells in Stroke: A Phase 1/2a Study

The Senior Learning Network

Health Train Express and the Senior Learning Network have agreed to provide content for seniors about health information technology, how to navigate the health insurance ecosystem, telemedicine, televideo and smartphone technology for health.

Senior Learning Network is a non-profit organization, providing content online for isolated seniors, for seniors living in assisted living, or in their own homes independently.

Senior Learning Network is partnered with another non-profit organization, Virtual Photo Walks




The content on the broadcasts is interactive, with multiple attendees who interact in real\-time during the two way video conference.

Telehealth and Televideo are becoming routine parts of the health system. In a previous Healthtrain Express post  we discussed

11 TOP PATIENT QUESTIONS ABOUT TELEHEALTH

Event Schedules can be found at the  Generations Learning Web site

These organizations offer much to seniors, and non-seniors alike. They offer entertainment events for community group meetings and a stimulus for socialization for those who would ordinarily not experience it.

Comments & Reviews:

NEW! OPEN WINDOWS:VOICES OF EXPERIENCE

This exciting series highlights older adults experiences, interests, talents, and hobbies. There is so much to share! This free series can be requested under our program section on the top of the menu bar.
A center could also put together panels on topics of interest- clean water, climate change, health care, spirituality, education,the arts etc. Whatever topic they have the expertise to present.

John Butterill and his staff of videographers takes  you on a Virtual Photowalk

 

Please join us on the journey.

Feds say Medicaid can pay for mosquito repellent to prevent Zika

Feds say Medicaid can pay for mosquito repellent to prevent Zika

D.C. Hospital Makes Frightening Discovery About Zika in Pregnancy | Healthcare of Tomorrow | US News

Detecting Zeka Viral microcephaly in utero is difficult because ultrasound changes of the fetal brain do not appear until near 20 weeks gestation.  The legal cut off for abortion is 21 weeks in most jurisdictions.  The brain's rapid growth begins at about 19-20 weeks at the threshold of detection..

Most doctors are using information that may be giving a false sense of security to pregnant women infected with Zika.

 Zika Emergence Evokes Memories of Rubella]

Retinal fundus photographs bear some resemblance to that of Rubella Retinopathy, a sign of Rubella, also a viral infection (not spread by mosquitos rather airborne person to person)

A study conducted in Brazil suggests that babies born with microcephaly caused by the Zika virus may develop eye problems that could lead to blindness.

The research, which comes from Stanford University and from Brazil, was published Wednesday in the journal Ophthalmology. It found that children can be at risk for bleeding of the retina and abnormal blood vessel development, resulting in blind spots or decreased peripheral vision or hemorrhaging that can result in vision loss.

The latest study was limited in scope, involving only three Brazilian babies, but the findings were enough to have the American Academy of Ophthalmology update its clinical statement on Zika, adding the new symptoms observed.

Authors of the study note that they do not yet know whether Zika causes the eye abnormalities or whether they result from microcephaly, a condition in which babies are born with abnormally small heads. Babies who live in countries that don't have treatment available to them – like laser surgery or medicines – will be more likely to have vision problems or even to go blind.

(as reported in USA News)

The retina is a part of the central nervous system (brain) and reflects what pathology is also present in the brain. This photograph of a retina from a newborn reveals optic atrophy, hemorrhages. amd retinal inflammation.

The findings are consistent 

The Centers for Disease Control and Prevention reported on Friday that nearly 280 pregnant women in the U.S. and its territories have the virus. Health officials fear that more pregnant women could become infected this summer as the weather gets warmer and mosquitoes become more rampant. Health officials may have difficulty tracking all adults infected in the U.S. because for the most part symptoms aren't noticeable or are otherwise mild. The most severe cases have resulted in Guillain-Barre syndrome, which causes paralysis, and in other cases adults have developed symptoms that are similar to multiple sclerosis. A patient in Puerto Rico died after being infected.



D.C. Hospital Makes Frightening Discovery About Zika in Pregnancy | Healthcare of Tomorrow | US News

‘We lose money doing this’: Tiny company caught in abortion debate takes on Congress -

PLACERVILLE, CALIF. — StemExpress, a tiny biomedical company in this foothill town east of Sacramento, has emerged at the heart of the contentious national debate over abortion and the scientific use of human fetal tissue. FBI agents say its floor-to-ceiling windows are security hazards, a potential line of sight for snipers. The backdrop of pine trees and hills provides cover, employees say, to strangers who crouch with cameras.

Inside, Melanie Rose, a laboratory technician, knows anyone could be watching. One recent May morning, she opened a foam box with fetal tissue packed in ice — a donation for medical research.

Rose, who is working toward a master’s degree in stem cell treatment, is one of 24 employees here thrust into view after antiabortion activists released a series of videos last year.

The videos shed light on an uncomfortable aspect of a little-known industry. They targeted Planned Parenthood, which provides abortions and, for a time, StemExpress paid a nominal fee to obtain the fetal tissue. The tissue, which is in limited supply, is a vital component in stem cell research — a great hope for medical breakthroughs. StemExpress collects the tissue and extracts the stem cells for researchers worldwide. Most of it is from adult sources — drawn from blood and bone marrow — but a small amount is from fetal tissue.

That work, with fetal tissue, has catapulted the small biotech firm out from under the radar. It is now the target of loiterers, protesters and death threats and the subject of a congressional inquiry.

At the heart of the issue is whether the work is done for profit. The exchange of fetal tissue for research is legal, so long as neither party makes money in the deal.

An undefined term is work done for profit. Whose profit ? Truth it be known,  most biological tissues are discarded as hazardous bio-waste, in special hazard containers. They are incinerated.   

Why do pro-lifers think that recycling biological waste is to be prohibited? This waste would be thrown away.  It is no longer living human tissue. It is unable to 'live' independently without extreme life support, perhaps in a tissue culture medium at best.  Harvesting early fetal remains as a result of an abortion, therapeutic or otherwise.  The fetus is dead ! Long live the fetal cells.

Are we destroying a life ? Our definition of life is hazy at best. It is an argument that will never end.  Some however like black and white answers because it eliminates the effort of careful thought and alternatives to conventional thinking.  The matter of equality and choice of rest rooms for transgenders becomes equal in the political spotlight along with abortion, and gay rights.  Our structured and catalogued life choices is disintegrating rapidly.

The choices are not black and white. they are different grays for each person.

House Republicans and antiabortion advocates assert that firms such as StemExpress do profit illegally and that that profit fuels a demand for abortions.

StemExpress chief executive Cate Dyer says profit is not a factor. “We lose money doing this,” Dyer said about working with fetal tissue. “We don’t have to do this, and we won’t stop doing this.”  And why is profit such a bad thing?  In no way can careful disposition of a biological waste substance be equated with a calculated murder, or even a negligent homicide. It's not solyent green, as many opposers would have us believe.

The consequences of this supercharged debate transcend one firm. Scientists and doctors across the country say the political turmoil on Capitol Hill has stalled lifesaving work and imperiled progress toward, among other treatments, a Zika virus vaccine.

“We want to accelerate lifesaving research,” Dyer said. “That’s what it’s all about. That is my passion.”

Dyer once worked as an emergency medical technician at Santa Barbara Cottage Hospital’s trauma center. Watching people die every day at the Southern California facility, she said, inspired her to search for ways to prevent death. She started the company in 2010 with $9,000 in savings. In 2015, StemExpress said it posted roughly $5 million in revenue.

Her company’s innovation, as she describes it, is isolating the stem cells from donor tissue from the clinic, which extends their lifespan for research. Otherwise, she said, a researcher in New York who wanted an adult liver in California would lose a substantial number of its usable cells during the cross-country flight.

Before the videos came out, Dyer said, StemExpress had never had so much as a threat. Hundreds have since hit the StemExpress inbox. She said a recent message was typical of what they’d received: “We know that you use aborted fetuses in your ‘research.’ Repent now before it is too late.”

Dyer said the company provides the samples to researchers at a financial loss to expedite the creation of medicines and vaccines — and that fetal tissue represents less than 1 percent of the business.

“I want to be able to focus on saving people’s lives,” Dyer said, “and instead I have to deal with death threats.”

David Daleiden, an activist who leads an outfit he calls the Center for Medical Progress, secretly shot the videos. He started looking into StemExpress after seeing a Craigslist posting for a contract job to collect tissue from a women’s health clinics.

"StemExpress is a business, and that’s clear from the list of products and bioservices on its website", Daleiden found it disturbing.

The company’s records indicate that roughly 1 percent of the tissue StemExpress collects is fetal. StemExpress typically gave Planned Parenthood $55 per sample, paying mostly for use of its rooms, storage and staffers.  Last year, a StemExpress catalog advertised a vial of two million “fresh” stem cells from a fetal liver for $1,932, and $1,840 for the same amount "cryopreserved," or frozen. Company records show they charge researchers a flat fee of $595 for each sample of fetal tissue, which costs an average $732 to prepare. In addition to compensating staffers who collect the tissue, the company pays for mileage, shipping, packaging, lab equipment, screening the sample for diseases and general upkeep.

In 2015, revenue from the transfer of fetal tissue to researchers totaled roughly $26,000. The cost of preparing the tissue, the company said, was about $33,000 — resulting in a $7,000 financial loss. That is not a profitable niche and certainly not a booming niche.  Part of the problem is the media's hype about biological research, genomics and computer science.  Much exaggeration and little truth.  The buzz words, even when spoken softly, elicit primal fears

There are already many safeguards in place about these issues.

The House Energy Committee’s Select Investigative Panel on Infant Lives has demanded that ­StemExpress and other biomedical players hand over thousands of pages of financial records and the names of their employees, issuing 36 subpoenas since March.

Its mission, according to its website, is to compile information about abortion providers and the biotech companies who “sell baby body parts.” The members plan to send their findings to Congress at the end of the year. On Tuesday, 180 of 188 House Democrats urged Speaker Paul D. Ryan (R-Wis.) to dissolve the panel, accusing it of harassment and McCarthyism.

Medical authorities have warned lawmakers that stigmatizing fetal tissue research could jeopardize public health. In March, the Association of American Medical Colleges — a group that includes the American Congress of Obstetricians and Gynecologists, Harvard University, and the Stanford University School of Medicine — sent a letter to congressional investigators.

The negative effects of these 'suspicious' activities has had a real negative impact on research.

Chilling effects on research

Those kinds of threats and the growing political pressure have chilled stem cell research at laboratories across the country.

Steven Goldman, a neurologist at the University of Rochester Medical Center in New York, said the outrage — and anxiety over becoming a target of it — has delayed his research on multiple sclerosis.

In 2012, Goldman’s team received a $12.1 million grant from the Empire State Stem Cell Board to develop a cure. The team extracted stem cells from fetal tissue — collected from abortions performed at local hospitals — to see whether they could regenerate myelin, the insulating sheath around nerve fibers, in mouse brains.

It worked, Goldman said. He and his colleagues planned to start clinical trials on late-stage multiple sclerosis patients this year. Since Daleiden’s first video, however, the researchers’ supply of fetal tissue dried up.

“Hospitals seemed less willing” to donate, Goldman said. “We’d never had significant rejections by patients, and all of the sudden they were turning down consent forms.”

Goldman has pushed his multiple sclerosis research schedule back to 2019.

“This kind of delay,” he said, “results in the additional deaths of people who could have been rescued.”

“If researchers are threatened, it’s going to make us think twice about continuing research,” she said, adding that her former boss has received death threats for her stem cell work. “Ultimately, the patients that could benefit from the research won’t.”

At the StemExpress lab, Dyer has hired armed guards, installed security cameras and put her staff through active-shooter training.

Rose, the 27-year-old lab technician, wears a silver Saint Christopher pendant for protection.

She cried when protesters first surrounded StemExpress, waving Bibles and photos of 

fetuses.  Now she tries to make eye contact through the windows. To smile.

When Rose sets to work, she breaks the tissue apart, then soaks it in enzymes and counts 

the number of stem cells on a grid under a microscope. She pours the cells into two-

milliliter vials, which are stored in liquid nitrogen tanks until they are shipped to a 

researcher at a university or major health institution.

“This tissue,” she said, “would be thrown away if we didn’t send it to researchers who are truly trying to save lives. I want them to see what I’m doing. That something good can come of it.”

This is certainly an issue that more Americans need to educate themselves about before making political decisions based  upon electoral rhetoric.. Don't let the politicians pick your brain apart. (they might sell the tissues for fund raising.)

‘We lose money doing this’: Tiny company caught in abortion debate takes on Congress - The Washington Post

The 2016 Physician's Guide to Opting Out of Medicare -

The 2016 Physician's Guide to Opting Out of Medicare - YouTube

11 TOP PATIENT QUESTIONS ABOUT TELEHEALTH

As we’ve written before, a majority of patients are now interested in doing telehealth visits.

If you are one of  them, this article will give you some of the basics.

The trick is getting them engaged and informed about how to do telehealth visits. How do you address their questions and anticipate any potential hesitations?

We’ve worked with many healthcare providers to develop their patient adoption plan, which gets the news out to patients and gets them excited to start! Once patients have their initial questions answered, they’re next question is usually “how do I sign up?”

With this in mind, we’ve gathered together 11 common patient questions we hear about telehealth, along with quick answers to give you a starting point as you’re communicating with your patients. Note that the answers will vary depending on your use case and the telehealth platform you’re using!

1. What do “telehealth” and “telemedicine” mean?

   Telehealth and telemedicine both describe a way to deliver and get healthcare using telecommunications technology (phone, computer). If you hear that your doctor is offering “live telehealth visits,” it means you can now videochat your doctor online!

2. What equipment do I need to do a telehealth visit?

   At minimum, most patients will need a computer or mobile device with an integrated camera and microphone. If your device doesn’t have a built-in microphone or webcam, you’ll need to get those. You also need a decent internet connection that allows you to stream video.

3. Will it work with wifi?

   Yes! As long as your wireless connection is strong enough. Your internet speeds should be at least 15mbps for uploads and 5mbps for downloads. You can check your internet speed by going to speedtest.net and clicking “Begin test.”

4. I’m not very tech-savvy. Is telehealth right for me?

   We’ve had patients of all ages (and well into their 90’s!) use our telehealth platform successfully. Have you ever used Skype or Facetime? Doing a virtual doctor’s visit can be just as simple.

5. What should I do if I have a technical issue?

   If you’re an eVisit user, you can simply contact our eVisit support team if you have any issues. We also include a quick equipment test when you enroll to make sure your sound, video etc is working, and lower the possibility of technical glitches.

6. What conditions can I get treated for via telehealth?

   Telehealth is currently being used to treat conditions across many different specialties. Here are just a few examples: Rashes, flu, sinus infections, UTI, migraines, acne, mental health counseling, substance abuse counseling, post-op check-ins, lab result reviews, contraceptive counseling, prescription refills, and much more. Check with you doctor to see what conditions they treat via telehealth.

7. How can the doctor diagnose me without actually doing a physical exam?

   Your doctor actually doesn’t need to do a physical exam to diagnose and treat many conditions. That’s because knowing your medical history is considered “90% of the evaluation” when combined with the doctor-patient interaction. How you’re feeling can be just as important to your doctor as the results of a physical exam. Plus, being able to see you and view any picture uploads on the eVisit platform gives your doctor the additional visual information needed to make a diagnosis.

8. How do I sign-up?

   The sign-up process can vary from provider to provider. Check your healthcare provider’s website for an eVisit login button or link. Simply click on that and answer a few questions about your medical history to get started.

9. When can I do virtual visits with my doctor?

   Check with your doctor about the specific hours they’ll be offering virtual visits. They might be offering on-demand visits during certain timeblocks or scheduling out your virtual visit the same way as an in-person appointment.

10. Will I be seeing my own doctor or someone I don’t know?

    This all depends on the practice you’re doing a telehealth visit with. If you’re doing a virtual visit with an urgent care center, chances are you’ll be seeing a new doctor.
    But if you’re doing a telehealth visit at a practice where you’re an established patient, you’ll likely be seeing your own doctor. Many practices treat telehealth visits the same as a normal in-person visit with your own doctor – except online!

11. Can I get a prescription filled from the visit?

    Yes! As long as your diagnosis doesn’t require further in-person examination, your doctor can simply electronically prescribe your medication and send it directly to the nearest pharmacy of your choice.

12. Will my insurance cover the visit?

    All of the Big Five insurance carriers (Aetna, BCBS, United Healthcare, Cigna, Humana) offer some sort of coverage for telehealth visits. However, you should always call your insurance and verify what your individual policy covers
13. Why should I use telehealth? 
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16. If you are a busy woman or man, the time and money saved can be signicant issue. Telehealth actually is a telephone call with video.  Most office or clinc visits are for a verbal confirmation and/or a discussion that can be accomplished using telemedicine. The time and money savings can be very significant, espcially if you are an hourly employee.  A typical office encounter can take as much as two hours, and consume several gallons of gas, all for a 15 minute face-face visit with your doctor.   Included in that time is waiting room time, processing time by the office staff and administrative paper work.